Ellis perhaps wisely locked the thread where he gave a URL for info regarding the impact of the SCOTUS (Supreme Court of the US) decision...but, I was both shocked and pleased at the result...there are some reasons (not for me personally) that give me a motive to hope that healthcare could advance not at the expense of individuals with/without health insurance (I pay a crapload as an independent contractor/artist/author).

As an American now living in Germany, I am happy to see America move forward with health care reform. I do not believe that Pres. Obama's package is perfect by any means, but it is definitely a step in the right direction. I have lived here in Germany for 2.5 years now. I pay into the German health and retirement system and I have nothing but good things to say about how it works. While I have not been to the doctor since moving here, my wife as well as her parents have been several times and the care is at the least as good as what you get in America and much better in some respects. And, the cost of health care is lower to the individual, whether working for a company, or more relevant to Jeff's post, those that are self-employed. I am self-employed, and I pay the same amount that any other person pays. Here in Germany, we can choose which private company we buy our insurance from. We do not depend on the government for our medical insurance as a lot of people think. We can choose our doctors, dentists etc., and there are not waiting lists or anything for treatment. At least not here in southern Baden-Württemberg. One real positive of our system here is that medicine is amazingly cheap compared to the prices in the USA. The cost of doctor's visits are much lower too.

Before moving here, I was 100% against the thought of such a health-care system, but now, I am a big fan.

But, in the end, the result of the health-care plan depends on the competence of the government running it. The U.S. Congress (Republicans as well as Democratic members) has a less than stellar record on competently managing anything. I think that is what has most people nervous and afraid. Maybe they can get a clue and get it right for a change.

I too was pleased by the result. As a parent of a child with a chronic condition it means a lot to me personally.

I am puzzled as to what there is to debate. We all need, and will use health care at some time in our lives.As the wealthiest nation on the planet, I see scant argument for letting large segments of the population go without protection and care. We are already paying for indigent care but at the highest possible price via emergency room care.

Probably the most instructive precedent is the huge fight that was waged in Congress in opposition to the Social Security Act. Virtually every American today sees SS as the benchmark of Government responsibility to its citizens. Yet at the time it was denounced as Socialism gone wild.

The kerfuffle over the act is really just political posturing. The act will be tweaked over time to smooth out the glitches and extend the coverage. As we become more familiar with the act we will appreciate it for the advance that it is..

There will be unintended consequences for sure but I am sure many will be surprised by the fact that some will be very positive.

the NHS is much maligned in the U.K. and while i have not had to use their services much my retired parents have between them had a fair few operations, including a triple bypass and neurosurgery on the spine (twice), thats at least £100,000 worth of care. all you have to do to get this service is pay your income tax.

But, in the end, the result of the health-care plan depends on the competence of the government running it. The U.S. Congress (Republicans as well as Democratic members) has a less than stellar record on competently managing anything. I think that is what has most people nervous and afraid. Maybe they can get a clue and get it right for a change.

Both Medicare and Social Security are run quite well, much more efficient than equivalent private programs. Not without problems, of course, but that's not the point.

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Not really. That's from 12 years ago. The Greek health system better than the NHS??? Don't think so...

That reflects the parlous state the Conservatives left the NHS in, and why Labour spent so much sorting it. Remember those waiting lists to get on the waiting lists, which were then some 18 months long? It took quite a lot to get those down to less than 18 weeks, and a matter of two or three in many cases.

Then there was the rampant MRSA as a result of contracting cleaning services to the lowest bidder. It cost millions to literally clean up their act, and millions upon millions to clear out MRSA.

The NHS was on its knees, and poor performance would have been the basis for mass privatisations. It seems as if a similar agenda is on Tory minds today.

In 2010, the UK was set to have overtaken both France & Germany in all metrics by 2013, and was already ahead in most. And the most cost-effective health service in the world.

That reflects the parlous state the Conservatives left the NHS in, and why Labour spent so much sorting it. Remember those waiting lists to get on the waiting lists, which were then some 18 months long? It took quite a lot to get those down to less than 18 weeks, and a matter of two or three in many cases.

Then there was the rampant MRSA as a result of contracting cleaning services to the lowest bidder. It cost millions to literally clean up their act, and millions upon millions to clear out MRSA.

The NHS was on its knees, and poor performance would have been the basis for mass privatisations. It seems as if a similar agenda is on Tory minds today.

In 2010, the UK was set to have overtaken both France & Germany in all metrics by 2013, and was already ahead in most. And the most cost-effective health service in the world.

I was equally stunned (in a good way!) by the outcome, I was prepared to see it go down in flames. And as Jeff can attest from our discussions about my own situation, I am a prime example of why (in my not so humble opinion!) we need this overhaul. I fall into that previously untouchable category of a " pre-existing condition." Fortunately, I work for a university and have outstanding coverage (and pay a lot for it…). Should I lose that coverage, my life expectancy would be measured in months. But now with this law, I cannot be denied (once it goes into effect).

I firmly believe that health care coverage is a responsibility that must be shared by all members of a society. I paid in for over thirty years before I needed it and now, I can't live with out it. I found it quite ironic in the early debates as politicians made such an issue about "death panels" deciding whether an individual was worthy of care. If denying coverage to someone with low income or a pre-existing condition isn't a "death panel," I don't know what is…

I found it quite ironic in the early debates as politicians made such an issue about "death panels" deciding whether an individual was worthy of care. If denying coverage to someone with low income or a pre-existing condition isn't a "death panel," I don't know what is…

Hi Greg,

When politicians stoop so low that only FUD tactics are left, it should be clear that they do not have sensible/rational arguments to support their case (and are probably in the wrong camp on that issue).

Looking at the situation from a (safe) distance, and basing my view on reports from amongst others the OECD, it seems that for some people the accessibility and overall cost of healthcare are less important than a dogmatic view on the role of government.

To me, such dogmatic views don't seem to lead to a pragmatic approach aimed at improving the quality/standards of living, unless one of course is one of the few at the excessive money receiving end of the situation and equates that to quality of life.

While the economy has slowed down medical costs have gone up.They will keep on gouging the real economy as much as they can until it becomes clear to everyone that it is simply racketeering.

Obama Care is a farce. What has it really changed except for forcing people to buy insurance.Has anything been done to control the cost of the medical services themselves.

Nothing will really change due to Americas political system that is a show really.There is not really any difference between the repuiblicans and the democrats.They just make a point in putting up a good show of pretending to really be in opposition to each other, but really they are just keeping the same old system going. The very rich get richer and the poor become more numerous.

Just look at "our" current president. Gets a Nobel peace Prize before even getting into office and then continues with the warsand adds a few little ones of his own. Pathetic, just like the rest of them. Clinton kept the war in Iraq warm while he filled the coffers so that Al Gore could abdicate" and let Bush spend all the money channeling the money to corporate America via a War. Too bad it destroyedcountless lives and most of Iraq.

Now he supports Gay Marriage.... well that was about time. Did he do so because he cares... no he did so because he can't afford to lose the young vote.

He pretended to be the green president. Then what did he do ... he plowed money into fake green companies that went belly upjust so the green movement would be discredited and that big oil could continue as usual.

He bailed out the American auto industry. Did he tell them to stop making dumb ass gas guzzling big dick SUVs. No.So now we are stuck with another couple of decades with cars will contribute to high pollution and fuel costs.

Let's go back to the Heath (they don't) Care issue. I'd be willing to bet that one thing that won't go away is that it will be compulsory to buy heath care insurance from a for profit company. That's what this move is really all about.It is about shoving compulsory insurance down your throat. The other good stuff will be taken down and the democrats knew it all along.

The last thing they want is the German national heath system.Incidently Germany is also the most Unionized industrial country.Seems to be doing very well that way.

Obama Care is a farce. What has it really changed except for forcing people to buy insurance.

From my understanding (that of a reasonably informed Brit, not an expert USAian), part of the change was to compel insurance companies to sell insurance to everyone. Putting the two together means no one is uninsured, no one is denied healthcare. Clearly there was more, but the change wasn't just about forcing people to spend their money.

What does seem quite clear is that health insurance companies were lobbying hard, trying to convince Republicans (who seemed to need little convincing anyway) to oppose it. Republican politicians were happy to act in the interests of big business rather than in the interests of US citizens. From my perspective this side of the Atlantic, that seems to be the case in all regards, not just healthcare.

From my understanding (that of a reasonably informed Brit, not an expert USAian), part of the change was to compel insurance companies to sell insurance to everyone. Putting the two together means no one is uninsured, no one is denied healthcare. Clearly there was more, but the change wasn't just about forcing people to spend their money.

That's my perception as well. What's more, allowing more people to join will allow to lower prices for all participants. Looking at the total health related expenditures in the USA, compared to pretty much the rest if the world, there seems to be an imbalance.

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What does seem quite clear is that health insurance companies were lobbying hard, trying to convince Republicans (who seemed to need little convincing anyway) to oppose it. Republican politicians were happy to act in the interests of big business rather than in the interests of US citizens. From my perspective this side of the Atlantic, that seems to be the case in all regards, not just healthcare.

Which should raise some questions when seen in relation to excessive cost for essentially not better quality care, and certainly not when seen in relation to denying access to humane care, it's unethical IMHO.

It's also counter productive when large parts of the population cannot participate in society/economy to their full capacity.

I went trough the public health system for a hip joint replacement here in Finland, and the total cost to me was about 220€, including 4 visits for doctor's examinations and several X-rays before the operation, the operation in a specialist hospital and 3 days/2 nights in the hospital. I am now on a 3 month fully paid sick leave, which does not affect my vacations this or next year. All this was provided with the government health insurance, I need not do anything about it. The payment is 2.12% of my salary paid straight by my employer (I do not even see it anywhere in my pay receipt), and all people get the same service, employed or not. For me very simple, and it works.

I went trough the public health system for a hip joint replacement here in Finland, and the total cost to me was about 220€, including 4 visits for doctor's examinations and several X-rays before the operation, the operation in a specialist hospital and 3 days/2 nights in the hospital. I am now on a 3 month fully paid sick leave, which does not affect my vacations this or next year. All this was provided with the government health insurance, I need not do anything about it. The payment is 2.12% of my salary paid straight by my employer (I do not even see it anywhere in my pay receipt), and all people get the same service, employed or not. For me very simple, and it works.

I wish you a speedy recovery.

I think it also illustrates the difference between having to, quoting Jeff, "pay a crapload as an independent contractor/artist/author" for insurance just in case one might or might not be struck by ill fate, and have a large collective chipping in to purchase the required service at a much more reasonable price only when it is actually needed.

It has more to do with efficiency, and caring for quality of life, than with clinging on to dogmas.

That of course is not an easy message with elections coming up in what is basically a two party system split down the middle which tends to polarize issues and make parties retreat to their trenches.

I went trough the public health system for a hip joint replacement here in Finland, and the total cost to me was about 220€, including 4 visits for doctor's examinations and several X-rays before the operation, the operation in a specialist hospital and 3 days/2 nights in the hospital. I am now on a 3 month fully paid sick leave, which does not affect my vacations this or next year. All this was provided with the government health insurance, I need not do anything about it. The payment is 2.12% of my salary paid straight by my employer (I do not even see it anywhere in my pay receipt), and all people get the same service, employed or not. For me very simple, and it works.

First your total cost was 2.12 percent of your total earnings (for how long?)plus 220.

Next how well do you think this scales up from 5 million+ to 300 million+ members where 30-45% make little or no contributions?

I think it also illustrates the difference between having to, quoting Jeff, "pay a crapload as an independent contractor/artist/author" for insurance just in case one might or might not be struck by ill fate, and have a large collective chipping in to purchase the required service at a much more reasonable price only when it is actually needed.

I'm curious, why is this any different that choosing to have car insurance which costs a "crapload" to protect yourself in case you crash your car?

I say this as an independent artist who pays over 12K per year for health insurance. Notice I said insurance. I do not expect "health care". I want financial protection for a bad situation, just like for my car. Just like my car I take care of the maintenance of my body from my own pocket. I surely would never expect the car insurance company to pay for my oil changes and tire rotations.

I make the choice to protect myself financially. I make the choice as to how much of the risk I choose to assume via the deductible.

More importantly I make the choice to structure my personal financial dealings to make sure I can cover the cost of this coverage.

In the end its all about my ability to choose. I would prefer the government not to take away my personal liberty.

I'm curious, why is this any different that choosing to have car insurance which costs a "crapload" to protect yourself in case you crash your car?

I say this as an independent artist who pays over 12K per year for health insurance. Notice I said insurance.

Hi Craig,

Just to give you an idea, and I know the situation is different in other countries but to provide some reference. In the Netherlands, each individual has a mandatory basic health insurance for hospital bills and visits to the doctor (currently 103 Eur/month, 1236 Eur/year or some USD 1513 at the current exchange rate). That's it. And we have one of the highest expenditures of the OECD countries.

The rest of the health care cost is covered by a percentage of one's income tax, so those who are unfortunate enough to have little or no income, also pay little or none.

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In the end its all about my ability to choose. I would prefer the government not to take away my personal liberty.

I can understand that, but that seems to come with an excessively high price tag, and what's more one which makes it much more expensive than it needs be, and only accessible to those who are 'lucky' enough to be able to pay "craploads" because it's so inefficient. There's a reason why the lobbyists for the insurance companies are trying to keep things as they are ...